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Well i know for sure that if you do an ER residency then do a subspecialty in peds (idk if this is the normal route) but if you did you could practice as a normal ER physician.
 
I'd focus a little more on college and excelling there than looking into specialties.
 
i'll bite because it's refreshing to see someone on hsdn that's not like "OMG imma be a brains surgeon!!!"

there are pretty much two routes anymore to becoming a peds ER doc. you can go:

a) pediatric residency (3 years) --> Peds ER fellowship (3 years)

b) ER residency (3 years) --> Peds ER fellowship (2 years)

If you know you just want to solely do ER than take route "b." You'd most likely get hired on as a Peds ER specialist, and then could work shifts in the adult ER on your days off to make extra money. Or you could work in a rural/underserved area, and cover people of all ages in the ER. This route is best if you know you want to work peds ER til you die (because its shortest). and really to be frank, if you just want a varied patient population, just go to an underserved area without a peds ER, and you'll take all comers anyway, even without a peds ER fellowship...

If you are excited by the ER, but want to work with kids specifically, go route "a." it does take a year longer, but its a good mix of primary care/procedures/some adrenaline. its really a nice change of pace for pediatricians who don't want to do primary care. and if you get burnt out working the ER lifestyle, you can go back to working just regular pediatric clinic 9-5...
 
:laugh: I don't think you would've gotten any responses if you said neurosurgeon either.

Btw I didn't know that you can do a pediatrics residency and then do an ER fellowship.

How much does that pay?

And that 9-5 doesn't sound like a bad deal once you burn out.... 😎

Sounds similar to a hospitalist in the sense that if one gets burnt out they can just go back to outpatient primary care.
 
i think it is around the mid 200's. from most of the doc's i've talked to, if you do the peds route, it's a big pay bump. but if you do the ER route, it's actually a pay cut haha. not that pay should guide your career choices too much. but something to think about!
 
I just matched in EM and spent a good amount of time on Peds EM because I thought it might be what I wanted to do, so I looked into it a lot. Sonofva gave a great overview but I figured I'd add some more stuff in case you have more questions.

Generally speaking, if you want great peds training, really want to know what the kiddos are going to do after you admit them etc- going the peds first route may be better (even though it's an extra year of training). You can then become a board certified general pediatrician before you go into fellowship, and as sonofva pointed out, that means that you can practice as a general pediatrician later if you want to. EM has a relatively high burnout rate, and peds EM is a particularly tough specialty from an emotional standpoint (you're often the one that first diagnoses cancer, or that deals with the kid who drowns in the pool, or the abused baby with a brain bleed etc...) so being able to go into gen peds is a nice escape route if working in the ED full time gets tough after a few years. Be aware however that you'd then take a pretty significant pay cut by switching- I'm talking literally getting paid half as much but probably working more hours- so there's that. My peds EM mentors used to also tell me that some of the better PEM fellowships prefer peds residents over EM residents just because they have so much more experience with kids- but I don't know if this is true.

On the other hand, if you love EM and also like working with adults, it might be better to go the EM route first and then decide whether you want to pursue the fellowship or not. I'll point out that the vast majority of ED's out there don't have a separate Peds ED so unless you work at an academic center where the two departments are completely separate and they only have PEM fellowship-trained docs working in the PED, you WILL see kids as a general EM doctor. This isn't just in rural/underserved areas at all, it's really the majority of places. Most programs I applied to have a separate PED, but during residency they send us over there a couple of times per month while we're on an EM rotation and then they often have peds-specific months as well. So as an EM-trained doctor, you're qualified to treat kids without a fellowship- however as a general pediatrician you really won't be able to work in the ED, and you obviously will not be seeing adults. Even at my current institution, where we have a huge separate PED, some of the adult EM attendings do shifts there once in a while because there aren't enough fellowship trained attendings to cover every shift. So you really are technically trained to take care of all ages.

For me, I ultimately chose to go the EM route. I enjoyed my time in the PED, but what I've found about it is that it's 95% boredom/ run of the mill stuff like upper respiratory infections in the winter or broken bones in the summer; and 5% pure panic. Kids get really sick really fast, though they also get better quickly. And often the tell-tale signs of "this guy's gonna go downhill soon" aren't there, and they just crash on you, and then you have screaming parents to contend with while you try to do your job. Kids don't really tend to have the chronic diseases adults often present to the ED with- in my experience they're either pretty much fine or really, really not. There's much less of a middle ground than you see with adults. This can be tough on people. I'd have shifts where literally nothing was wrong with any of my kids and I'd just tell them to follow up with their pediatrician. Then on my next shift I'd have a former premature baby with heart defects who'd come in septic, and that would just be chaos. Or a 4 year old presenting with something really mundane who turned out to have inoperable cancer. It's a weird place.
 
Anon212 said:
I just matched in EM and spent a good amount of time on Peds EM because I thought it might be what I wanted to do, so I looked into it a lot. Sonofva gave a great overview but I figured I'd add some more stuff in case you have more questions.
Click to expand...

Nice
 
Anon212 said:
I just matched in EM and spent a good amount of time on Peds EM because I thought it might be what I wanted to do, so I looked into it a lot. Sonofva gave a great overview but I figured I'd add some more stuff in case you have more questions.

Generally speaking, if you want great peds training, really want to know what the kiddos are going to do after you admit them etc- going the peds first route may be better (even though it's an extra year of training). You can then become a board certified general pediatrician before you go into fellowship, and as sonofva pointed out, that means that you can practice as a general pediatrician later if you want to. EM has a relatively high burnout rate, and peds EM is a particularly tough specialty from an emotional standpoint (you're often the one that first diagnoses cancer, or that deals with the kid who drowns in the pool, or the abused baby with a brain bleed etc...) so being able to go into gen peds is a nice escape route if working in the ED full time gets tough after a few years. Be aware however that you'd then take a pretty significant pay cut by switching- I'm talking literally getting paid half as much but probably working more hours- so there's that. My peds EM mentors used to also tell me that some of the better PEM fellowships prefer peds residents over EM residents just because they have so much more experience with kids- but I don't know if this is true.

On the other hand, if you love EM and also like working with adults, it might be better to go the EM route first and then decide whether you want to pursue the fellowship or not. I'll point out that the vast majority of ED's out there don't have a separate Peds ED so unless you work at an academic center where the two departments are completely separate and they only have PEM fellowship-trained docs working in the PED, you WILL see kids as a general EM doctor. This isn't just in rural/underserved areas at all, it's really the majority of places. Most programs I applied to have a separate PED, but during residency they send us over there a couple of times per month while we're on an EM rotation and then they often have peds-specific months as well. So as an EM-trained doctor, you're qualified to treat kids without a fellowship- however as a general pediatrician you really won't be able to work in the ED, and you obviously will not be seeing adults. Even at my current institution, where we have a huge separate PED, some of the adult EM attendings do shifts there once in a while because there aren't enough fellowship trained attendings to cover every shift. So you really are technically trained to take care of all ages.

For me, I ultimately chose to go the EM route. I enjoyed my time in the PED, but what I've found about it is that it's 95% boredom/ run of the mill stuff like upper respiratory infections in the winter or broken bones in the summer; and 5% pure panic. Kids get really sick really fast, though they also get better quickly. And often the tell-tale signs of "this guy's gonna go downhill soon" aren't there, and they just crash on you, and then you have screaming parents to contend with while you try to do your job. Kids don't really tend to have the chronic diseases adults often present to the ED with- in my experience they're either pretty much fine or really, really not. There's much less of a middle ground than you see with adults. This can be tough on people. I'd have shifts where literally nothing was wrong with any of my kids and I'd just tell them to follow up with their pediatrician. Then on my next shift I'd have a former premature baby with heart defects who'd come in septic, and that would just be chaos. Or a 4 year old presenting with something really mundane who turned out to have inoperable cancer. It's a weird place.
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So generally speaking, you would like to care "sicker" patients because the the case variety they present is more interesting?
 
Arijos0222 said:
So generally speaking, you would like to care "sicker" patients because the the case variety they present is more interesting?
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While I agree with everything he has said training wise, the all-comer ED isn't much better in terms of actual emergencies, the vast majority of stuff that comes through could/should have waited to see their family doc (if they had one).

Still a great field, and I was very torn between EM and what I ultimately chose.
 
Arijos0222 said:
So generally speaking, you would like to care "sicker" patients because the the case variety they present is more interesting?
Click to expand...

I guess that's one way of putting it. I like adult medicine because there's a huge variety of things that could be going on, and a huge number of things we can do about them. A patient comes in with a cough/ shortness of breath- it could be anything from a cold to heart failure to lung cancer to rare stuff. Chest pain can be a zillion things, and about 5ish of them can kill you in minutes. Also, you just have a lot more options as far as stuff you actually can do as an EM physician with adults. You're usually more likely to do procedures on adults than you are on kids. Finally, adults often tend to have a lot of comorbidities (it's rare that you have a pure heart patient- generally they also have funky kidneys, peripheral vascular disease, they're smokers, diabetic etc) which offer a more complex diagnostic and treatment challenge. And they're often on multiple meds which you have to work with carefully. It's tricky, but usually EM doctors are the types to thrive under that kind of pressure and to enjoy diagnostic and management puzzles.

With kids for the most part things are simpler. Don't get me wrong, congenital defect kids are a nightmare- but there's zero way I as an EM doctor would mess too much with a congenital heart baby without getting cardiology involved, so my job is more limited. Kids also tend to be overall healthier, they usually don't have too many comorbidities to worry about, and they're usually not on any meds. Yes, there are definitely some special cases- but it's rare to meet a child who has heart disease and diabetes and hypertension and is on 15 meds, while it's common on the adult side. If you're an adrenaline junkie, then I can assure you that nothing will get your heart pumping as much as a baby or child who's trying to die on you. But those cases are (thankfully for everyone involved) rare. The rest of it is usually pretty unremarkable.
 
Dwindlin said:
While I agree with everything he has said training wise, the all-comer ED isn't much better in terms of actual emergencies, the vast majority of stuff that comes through could/should have waited to see their family doc (if they had one).

Still a great field, and I was very torn between EM and what I ultimately chose.
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What did you choose?
 
Anon212 said:
I guess that's one way of putting it. I like adult medicine because there's a huge variety of things that could be going on, and a huge number of things we can do about them. A patient comes in with a cough/ shortness of breath- it could be anything from a cold to heart failure to lung cancer to rare stuff. Chest pain can be a zillion things, and about 5ish of them can kill you in minutes. Also, you just have a lot more options as far as stuff you actually can do as an EM physician with adults. You're usually more likely to do procedures on adults than you are on kids. Finally, adults often tend to have a lot of comorbidities (it's rare that you have a pure heart patient- generally they also have funky kidneys, peripheral vascular disease, they're smokers, diabetic etc) which offer a more complex diagnostic and treatment challenge. And they're often on multiple meds which you have to work with carefully. It's tricky, but usually EM doctors are the types to thrive under that kind of pressure and to enjoy diagnostic and management puzzles.

With kids for the most part things are simpler. Don't get me wrong, congenital defect kids are a nightmare- but there's zero way I as an EM doctor would mess too much with a congenital heart baby without getting cardiology involved, so my job is more limited. Kids also tend to be overall healthier, they usually don't have too many comorbidities to worry about, and they're usually not on any meds. Yes, there are definitely some special cases- but it's rare to meet a child who has heart disease and diabetes and hypertension and is on 15 meds, while it's common on the adult side. If you're an adrenaline junkie, then I can assure you that nothing will get your heart pumping as much as a baby or child who's trying to die on you. But those cases are (thankfully for everyone involved) rare. The rest of it is usually pretty unremarkable.
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That seems very challenging. Personally I've been more of a "do-er" rather than a "thinker"... Which leads me more towards Dentistry and more procedure based careers.
nysegop said:
loljk

I am willing to see blood and cuts, but the hardest part of medicine for me will be dealing with genitals. Especially sticking tubes in penises and such.
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I think the hardest thing at first would be OBGYN.

Oh and anatomy lab. My friend who's a 1st year (female) cried when she had to dissect near the face of the person.
 
nysegop said:
How's the premed program at Ohio State? My uncle went there so I'm considering applying there.
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Didn't go there. Just another Ohio resident who is a giant OSU fan. I studied music right out of high school, then became a firefighter, then did pre-med garbage (and I assure you beyond MS1 it's garbage 🙂 ) at a satellite campus.

Couple of my friend are grads and loved their time in Columbus. Probably one of the few regrets I have is not going there, had an acceptance, but at the time I wanted to be a musician and I had much better acceptances. Hindsight is 20/20 though.
 
Dwindlin said:
Anesthesia.
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Please give us a breakdown as to what your decision making was in choosing anesthesia

I know of a 3rd year resident at the UWSL who chose anesthesia over his true love (General Surg) because of a better lifestyle which was one of the main reasons
 
Arijos0222 said:
Please give us a breakdown as to what your decision making was in choosing anesthesia

I know of a 3rd year resident at the UWSL who chose anesthesia over his true love (General Surg) because of a better lifestyle which was one of the main reasons
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Loved being in the OR, hated being sterile. Don't mind taking call, but when I'm off I want to be off. Don't want to run a business, or worry about bringing in/keeping my own patients. Not interested in long term care. Love critical care. Parts I love about being a medic I still get to do (airway management, IVs), plus lots of other little great procedures (central lines, neuraxial anesthesia, peripheral blocks). Patients love you, even if they don't really know you, they know that your the one who is going to keep them breathing and as pain free and possible.

So, as you can see a lot of that could apply to EM. And with my background it's where I thought I would end up. So why one over the other? Honestly came down to "feeling." During my EM month, I left the hospital every day in a worse mood than I arrived, was quite the opposite for anesthesia, even though I worked far more hours in anesthesia than EM.

Lifestyle is always in the back of your mind, but honestly I'll likely have a worse lifestyle in anesthesia as my interest lies in high acuity sick patients. Working with those patient populations tend to afford a relatively crappy lifestyle (more call, emergencies, more stress intraop/PACU) when compared to the outpatient surgicenter gigs.
 
I considered anesthesia, but I'd rather do surgery. That may change when I go to medical school, get married, have kids. I'll probably be gunning for derm by then. Haha. Lifestyle isn't as important to a high schooler. It will become important as I get older.
 
Dwindlin said:
Loved being in the OR, hated being sterile. Don't mind taking call, but when I'm off I want to be off. Don't want to run a business, or worry about bringing in/keeping my own patients. Not interested in long term care. Love critical care. Parts I love about being a medic I still get to do (airway management, IVs), plus lots of other little great procedures (central lines, neuraxial anesthesia, peripheral blocks). Patients love you, even if they don't really know you, they know that your the one who is going to keep them breathing and as pain free and possible.

So, as you can see a lot of that could apply to EM. And with my background it's where I thought I would end up. So why one over the other? Honestly came down to "feeling." During my EM month, I left the hospital every day in a worse mood than I arrived, was quite the opposite for anesthesia, even though I worked far more hours in anesthesia than EM.

Lifestyle is always in the back of your mind, but honestly I'll likely have a worse lifestyle in anesthesia as my interest lies in high acuity sick patients. Working with those patient populations tend to afford a relatively crappy lifestyle (more call, emergencies, more stress intraop/PACU) when compared to the outpatient surgicenter gigs.
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Yeah and this last point I think is important and under-appreciated by pre-meds I find. The truth is that you can basically make your life as easy or as hard as you want depending on what you choose. Anesthesia is touted as a "lifestyle specialty" but honestly a good chunk of the people going into anesthesia nowadays are interested in critical care (I suspect this is because so much of the "running your own room" perioperative anesthesia has been taken over by CRNAs), and that has a relatively tough lifestyle and is very high-stress. Radiology has gotten tougher from a job hunt perspective (nowadays you basically have to do a fellowship in order to be competitive, as far as I understand), and the money has decreased. Primary care hours vary considerably among physicians based on personal choice. Et cetera. There's a lot of room in medicine to do your own thing and work around what really matters to you.
 
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